How we do user-centred design for citizen-facing services – part two

By Matt Edgar. 9 November 2017

In part one of this series, I talked about the different kinds of user needs our services have to meet – clinical, practical and emotional – and introduced the six principles of the international standard for human-centred design.

This post is to tell you more about those principles, and how we apply them in our work on citizen-facing services at NHS Digital.

1. The design is based upon an explicit understanding of users, tasks and environments.

You’ll have picked up by now that we focus sharply on understanding who our users are. We also research to understand:

what they’re trying to accomplish

the steps they’ll take to get there, and

the context in which they’ll be using our service.

We do this at the overall level of a service, and when developing specific features and information.

Take, for example, the page about insomnia on our new beta website. We know about 70% of NHS Choices visits come from mobile phones. For this page that proportion is even higher: 86% in one week. The most common time for visits? 20% of sessions are between 11pm and 2am. Can you picture the context of use here?

As well as being clinically accurate, our information about insomnia might need to be designed for reading with tired eyes, on a small, bright screen in a darkened room. Maybe it should address the emotional needs of someone turning to the NHS for help getting to sleep in the middle of the night.

2. Users are involved throughout design and development.

We all make assumptions about user needs, but that’s all they are – assumptions – until we test them out with actual users of our service.

Our user researchers have many different ways of involving users in the design and development process.

Right from the beginning, they can interview users, and visit their homes and workplaces. As we come up with ideas, they can observe users trying out early versions of the service. Designers and researchers can facilitate co-design sessions with users in the room, creating and improving designs together.

The NHS provides a comprehensive service, available to all. Our digital services need to reflect the diversity of the population, and be accessible to as many people as possible, including users with disabilities.

3. The design is driven and refined by user-centred evaluation.

As designers, we owe it to our users and our researchers to do things differently based on the things they learn. We take that responsibility very seriously.

The picture here is from the team working on GP pages for the new beta website. Every sticky note is a comment or proposed change to the way this page works, based on user research and insights from data.

4. The process is iterative.

Designers hardly ever get it right first time. A big part of the design process is iteration – going back over a design many times, making small improvements and testing alternative solutions to a problem.

Here’s an example of one such improvement from the team working on medicines information.

The first version of the page about paracetamol combined information about the medicine for adults and children.

In research, users with children worried about getting confused between the two. The emotional need for parents and carers is to get the right information quickly while their child is in pain.

The team’s solution was to create dedicated sections for children and adults, using tabs to keep them separate. The solution tested well, as users who cared for children were relieved to see the information separated out.

We’re not done yet, though. The ‘tabs’ solution doesn’t work so well on mobile devices, so the team plans to revisit that in a future iteration.

5. The design addresses the whole user experience.

Often at NHS Digital, we’re designing just a small part of what the user experiences. For example, booking an appointment is a small but necessary part of accessing an in-person medical consultation. We still need to understand all of that experience, including the non-digital bits, and the parts of the service delivered by other people.

The team on type 1 diabetes worked with patients to map their journey, from first symptoms through diagnosis and on to self-management. They charted the emotional highs and lows as well as the practical and clinical steps.

Every one of those pink sticky notes shows a quote or an insight from research with patients. Below the line, the green sticky notes are quotes and insights from clinicians too.

6. The design team includes multidisciplinary skills and perspectives.

Great user experiences are made when people with different skills collaborate. Gone are the days of the hero designer who works alone.

Our teams include different kinds of designer – service designers, interaction designers, graphic designers and content designers. They in turn work with other specialists including product managers, user researchers, developers, technical architects, web ops, delivery managers and clinical experts.

Clinicians, designers and technologists have to communicate clearly with each other, avoiding acronyms and jargon. This has an additional benefit: if we’re clear with each other, it means we’re more likely to make things simple for our users.

In the final part of this series I will talk about evidence – how we use it to shape our designs and check if they’re working in practice.